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Detection of anticonductive tissue autoantibodies in a patient with chronic intestinal pseudo-obstruction and sick sinus syndrome.
- Source :
-
European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2013 Nov; Vol. 25 (11), pp. 1358-63. - Publication Year :
- 2013
-
Abstract
- A 26-year-old patient was diagnosed as having chronic intestinal pseudo-obstruction with manometric and histopathologic features suggestive of an intestinal myopathy. Histology was characterized by smooth muscle degeneration without inflammatory or immune cells. The severe gut dysfunction required full parenteral nutritional support. After a few months, the patient developed symptomatic tachy-brady arrhythmia episodes with syncopes. A thorough diagnostic work-up led to a diagnosis of sick sinus syndrome, which was managed by pacemaker implantation and administration of β-blockers. This led to a partial improvement in tachy-brady arrhythmia episodes. Nonetheless, the patient continued to experience sustained supraventricular tachyarrhythmia runs, poorly responsive to increasing β-blocker doses. To investigate the origin of the cardiologic impairment, the patient was tested for anticonductive tissue autoantibodies, which were positive, thus supporting a possible autoimmune origin of the dysrhythmia. Other autoantibodies were negative. On the basis of these findings, the patient was treated with high-dose steroids, which were then tapered. The patient responded to the steroid treatment and did not experience further episodes of syncope and tachyarrhythmias. The severe gut dysfunction remained unchanged. This case highlights an association between severe gut dysfunction and cardiac conductive tissue abnormalities, with autoantibodies to conductive tissue possibly causing the dysrhythmia. The severe gut and heart (likely autoimmune-mediated) dysfunction presented in this case provides a basis to further assess a link between intestinal and cardiac abnormal rhythmicity.
- Subjects :
- Adult
Glucocorticoids therapeutic use
Humans
Intestinal Pseudo-Obstruction complications
Intestinal Pseudo-Obstruction pathology
Male
Muscle, Smooth pathology
Sick Sinus Syndrome complications
Sick Sinus Syndrome drug therapy
Autoantibodies blood
Autoimmune Diseases immunology
Heart Conduction System immunology
Intestinal Pseudo-Obstruction immunology
Sick Sinus Syndrome immunology
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5687
- Volume :
- 25
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- European journal of gastroenterology & hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 24081107
- Full Text :
- https://doi.org/10.1097/MEG.0b013e3283632dbc